Salts of trimebutine and n-desmethyl trimebutine

ABSTRACT

Unique salts of trimebutine and N-monodesmethyl trimebutine, and their corresponding stereoisomers, having improved analgesic properties useful in the treatment of visceral pain are provided. The salts of the present invention are particularly useful in the treatment of conditions characterized by abdominal pain, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), diabetic gastroparesis, and dyspepsia.

This application claims the benefit of U.S. provisional patentapplication No. 60/804,067, filed Jun. 6, 2006.

FIELD OF INVENTION

The present invention relates to unique salts of trimebutine andN-monodesmethyl trimebutine, and their corresponding stereoisomers,having improved analgesic properties useful in the treatment of visceralpain in general and more particularly in the treatment of conditionscharacterized by abdominal pain, for example, in patients withintestinal diseases such as inflammatory bowel disease (IBD) andirritable bowel syndrome (IBS), diabetic gastroparesis, and dyspepsia.

BACKGROUND OF THE INVENTION

Trimebutine[3,4,5-trimethoxybenzoic acid2-(dimethylamino)-2-phenylbutylester and its maleate salt] has been usedin many countries since 1969 for the treatment of functional boweldisorders, including IBS. The efficacy of trimebutine to relieveabdominal pain has been demonstrated in various clinical studies (see,for example, Ghidini et al (1986) Single drug treatment for irritablecolon: Rociverine versus trimebutine maleate. Curr Ther Res 39:541-548). Trimebutine has proved to be effective in the treatment ofboth acute and chronic abdominal pain in patients with functional boweldisorders, especially IBS, at doses ranging from 300 to 600 mg/day. Itis also effective in children presenting with abdominal pain.

It is thought that the actions of trimebutine on the gastrointestinaltract are mediated in part via (i) an agonist effect on peripheral mu,kappa and delta opiate receptors and (ii) release of gastrointestinalpeptides such as motilin and modulation of the release of otherpeptides, including vasoactive intestinal peptide, gastrin and glucagon.Further, trimebutine accelerates gastric emptying, induces prematurephase III of the migrating motor complex in the intestine and modulatesthe contractile activity of the colon. Recently, trimebutine has alsobeen shown to decrease reflexes induced by distension of the gut lumenin animals to modulate visceral sensitivity.

Nitric oxide (NO) been recently been shown to exert manyanti-inflammatory effects, including reduction of leukocyte adherence tothe vascular endothelium (Gauthier et at (1994) Nitric oxide attenuatesleukocyte-endothelial interaction via P-selectin in splanchnicischemia-reperfusion. Am J Physiol 267: G562-G568) and suppression ofproduction of various chemotactic factors (Walford and Loscalzo (2003)Nitric oxide in vascular biology. J Thromb Haemost 1: 2112-2118).Further, incorporation of an NO-releasing moiety into certain drugs suchas NSAIDs, acetaminophen and ursodexycholic acid has been shown toenhance activities of these drugs and reduce toxicity relative to theparent drug.

Hydrogen sulfide (H₂S) is another type of gaseous mediator that mayexert anti-inflammatory effects Recently it has been shown that H₂Sreleasing agents exhibit analgesic activity in models of visceral pain(Distrutti et at (2005) Evidence that hydrogen sulfide exertsantinociceptive effects in the gastrointestinal tract by activatingK_(ATP) channels. J Pharmacol Exp Ther 316: 325-335. Further, H₂S hasbeen shown to be a smooth muscle relaxant in intestinal tissues (seeTeague, B. et al. (2002) The Smooth Muscle Relaxant effect of HydrogenSulfide in Vitro: Evidence for a Physiological Role to ControlIntestinal Contractility. Br. J. Pharmacol. 137: 139-145.

The inventors have shown in the present application that the activity oftrimebutine is significantly enhanced when salts of trimebutine orN-monodesmethyl trimebutine and their corresponding stereoisomers areformed with various NO-releasing, H₂S-releasing or combined NO- andH₂S-releasing moieties. In particular, administration of theseNO-releasing, H₂S-releasing or combined NO- and H₂S-releasing salts oftrimebutine and N-monodesmethyl trimebutine results in improvedanalgesic properties when compared to trimebutine (trimebutine maleate)or its metabolite N-monodesmethyl trimebutine alone and when compared tothe NO-releasing, H₂S-releasing or combined NO- and H₂S-releasing moietyalone. These salts are particularly useful in the treatment ofconditions characterized by abdominal pain such as such as irritablebowel syndrome, inflammatory bowel disease, diabetic gastroparesis,dyspepsia and the like.

SUMMARY OF THE INVENTION

In general, salts of trimebutine (TMB) and its active metaboliteN-desmethyl trimebutine (Nor-TMB) and their corresponding stereoisomers,(R)-TBM, (S)-TMB, (R)-Nor-TBM and (S)-Nor-TBM, are provided, said saltsbeing formed using NO-releasing, H₂S-releasing or combined NO- andH₂S-releasing moieties. By forming a salt with an NO-releasing,H₂S-releasing or combined NO- and H₂S-releasing moiety, theanti-nociceptive effect of TMB and Nor-TMB was surprisingly enhanced.

More particularly, the TMB and Nor-TMB salts of the present inventionare superior to TMB and Nor-TMB alone and to an NO-releasing,H₂S-releasing or combined NO- and H₂S-releasing moiety alone in reducingvisceral pain associated with colorectal distension. The NO-releasing,H₂S-releasing or combined NO- and H₂S-releasing moieties alone did notappear to have any significant effects on visceral pain associated withcolorectal distension when administered alone. Thus, in one aspect ofthe invention, the salts of the present invention are useful inalleviating pain associated with any disorder of the digestive systemthat is associated with abdominal pain.

Broadly stated, salts of the invention have the following generalformula:

A⁺·X⁻  (formula I)

where:

-   A is

-   and their corresponding stereoisomers;-   and X is a NO-releasing, H₂S-releasing or combined NO- and    H₂S-releasing moiety.

In a preferred embodiment, X is selected from the group consisting of:

It is understood that any non-toxic, effective NO-releasing,H₂S-releasing or combined NO- and H₂S-releasing moiety can be used inthe present invention.

Preferred compounds are those of the following formulae:

Further, novel combined NO- and H₂S-releasing moieties are providedhaving the general formula, nitroarginine-R, preferably:

wherein R is an H₂S-releasing moiety. In a preferred embodiment, R isselected from the group consisting of5-p-hydroxyphenyl-1,2-dithione-3-thione, cysteine, and4-(thiocarbamoyl)benzoic acid.

Further, a method for treating visceral pain in a subject in need ofsuch treatment is provided comprising administering to the subject avisceral pain relieving amount of a compound of the present invention.In one embodiment, the visceral pain is abdominal pain. In anotherembodiment, the abdominal pain is due to intestinal diseases such asinflammatory bowel disease (IBD), irritable bowel syndrome (IBS),diabetic gastroparesis, and dyspepsia.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1( a) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle and trimebutine maleate.

FIG. 1( b) shows the colorectal pressure (mmHg) in a rat model ofvisceral pain perception using vehicle and trimebutine maleate alone.

FIG. 2( a) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle and nitroarginine alone.

FIG. 2( b) shows the colorectal pressure (mmHg) in a rat model ofvisceral pain perception using vehicle and nitroarginine alone.

FIG. 3( a) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle and trimebutine nitroargininate(salt I).

FIG. 3( b) shows the colorectal pressure (mmHg) in a rat model ofvisceral pain perception using vehicle and trimebutine nitroargininate(salt I).

FIG. 4( a) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle or trimebutine nitroargininate(salt I), with or without pretreatment with L-NAME.

FIG. 4( b) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle or trimebutine nitroargininate(salt I), with or without pretreatment with methylene blue.

FIG. 5( a) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle, trimebutine maleate andtrimebutine thiocarbamoylbenzoate (salt III).

FIG. 5( b) shows the perception score (AWR Score) in a rat model ofvisceral pain perception using vehicle and thiocarbamoylbenzoate (TBZ)alone.

FIG. 6 is a bar graph showing H₂S generation of 4-(thiocarbamoyl)benzoicacid (TBZ) and 5-(4-amino-phenyl)-[1,2]dithiole-3-thione (ADT-OH).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The invention will now be described with respect to preferredembodiments described herein. It should be appreciated however thatthese embodiments are for the purpose of illustrating the invention, andare not to be construed as limiting the scope of the invention asdefined by the claims.

The compounds of the present invention contain two active moieties, (1)either TMB or Nor-TMB, or their stereoisomers, and (2) an NO-releasingmoiety, an H₂S-releasing moiety, or combined NO- and H₂S-releasingmoieties. In many instances, the salts of the present invention can bemade using known starting materials and reagents.

Compounds of the present invention may be utilized for the treatment ofvisceral pain, such as abdominal pain, associated with various diseases,including, but not limited to, Crohn's disease, ulcerative colitis,irritable bowel syndrome, infectious colitis (e.g., pseudomembranouscolitis such as Clostridium difficile colitis, salmonella enteritis,shigella infections, yersiniosis, cryptospiridiosis, microspridialinfections, and viral infections), radiation-induced colitis, colitis inthe immunocompromised host, diabetic gastroparesis and dyspepsia.

Depending on the specific condition or disease state to be treated,subjects may be administered compounds of the present invention at anysuitable therapeutically effective and safe dosage, as may be readilydetermined within the skill of the art. These compounds are, mostdesirably, administered in dosages ranging from about 1 to about 2000 mgper day, in a single or divided doses, although variations willnecessarily occur depending upon the weight and condition of the subjectbeing treated and the particular route of administration chosen.However, a dosage level that is in the range of about 0.1 to about 100mg/kg, preferably between about 5 and 90 mg/kg, and more preferablybetween about 5 and 50 mg/kg, is most desirable. Variations maynevertheless occur depending upon the weight and conditions of thepersons being treated and their individual responses to said medicament,as well as on the type of pharmaceutical formulation chosen and the timeperiod and interval during which such administration is carried out. Insome instances, dosage levels below the lower limit of the aforesaidrange may be more than adequate, while in other cases still larger dosesmay be employed without causing any harmful side effects, provided thatsuch large doses are first divided into several small doses foradministration throughout the day.

The compounds of the present invention can be administered in the formof any pharmaceutical formulation, the nature of which will depend uponthe route of administration. These pharmaceutical compositions can beprepared by conventional methods, using compatible, pharmaceuticallyacceptable excipients or vehicles. Examples of such compositions includecapsules, tablets, transdermal patches, lozenges, troches, sprays,syrups, powders, granulates, gels, elixirs, suppositories, and the like,for the preparation of extemporaneous solutions, injectablepreparations, rectal, nasal, ocular, vaginal etc. A preferred route ofadministration is the oral and rectal route.

For oral administration, tablets containing various excipients such asmicrocrystalline cellulose, sodium citrate, calcium carbonate, dicalciumphosphate and glycine may be employed along with various disintegrantssuch as starch (preferably corn, potato or tapioca starch), alginic acidand certain complex silicates, together with granulation binders likepolyvinylpyrrolidone, sucrose, gelatin and acacia. Additionally,lubricating agents such as magnesium stearate, sodium lauryl sulfate andtalc can be used for tabletting purposes. Solid compositions of similartype may also be employed as fillers in gelatin capsules; preferredmaterials in this connection also include lactose or milk sugar, as wellas high molecular weight polyethylene glycols. When aqueous suspensionsand/or elixirs are desired for oral administration the active ingredientmay be combined with sweetening or flavoring agents, coloring matterand, if so desired, emulsifying and/or suspending agents, together withsuch diluents as water, ethanol, propylene glycol, glycerin and variouscombinations thereof.

The dosage form can be designed for immediate release, controlledrelease, extended release, delayed release or targeted delayed release.The definitions of these terms are known to those skilled in the art.Furthermore, the dosage form release profile can be effected by apolymeric mixture composition, a coated matrix composition, amultiparticulate composition, a coated multiparticulate composition, anion-exchange resin-based composition, an osmosis-based composition, or abiodegradable polymeric composition. Without wishing to be bound bytheory, it is believed that the release may be effected throughfavorable diffusion, dissolution, erosion, ion-exchange; osmosis orcombinations thereof.

For parenteral administration, a solution of an active salt in eithersesame or peanut oil or in aqueous propylene glycol can be employed. Theaqueous solutions should be suitably buffered (preferably pH greaterthan 8), if necessary, and the liquid diluent first rendered isotonic.The aqueous solutions are suitable for intravenous injection purposes.The preparation of all these solutions under sterile conditions isreadily accomplished by standard pharmaceutical techniques well known tothose skilled in the art.

The following non-limitative examples further describe and enable aperson ordinarily skilled in the art to make and use the invention.

Preparation of Compounds EXAMPLE 1 Synthesis of trimebutinenitroargininate (I)

To a mixture of H-Arg(NO₂)—OH (0.1 mole) and trimebutine (0.1 mole),water (200 mL) and ethyl alcohol (20 mL) have been added and theresulting suspension has been stirred at room temperature until clear.Then the solution has been frozen and lyophilized furnishing the desiredsalt (quantitative yield).

¹H-NMR (400 MHz, DMSO-d₆): δ 0.60 (t, 3H), 1.45-1.75 (m, 4H), 1.80-1.90(m, 2H), 2.25 (s, 6H), 2.90-3.40 (m, 2H), 3.75 (s, 9H), 3.95 (m, 1H),4.64 (dd, 2H), 7.15 (s, 2H), 7.22 (t, 1H), 7.35 (t, 2H), 7.46 (d, 2H).

¹³C-NMR (400 MHz, DMSO-d₆): δ 9.07, 22.8, 26.4, 28.9, 29.1, 47.9, 56.4,60.8, 64.4, 65.8, 107.3, 125.2, 127.4, 128.0, 128.5, 141.7, 142.5,153.4, 158.3, 165.9, 170.2.

mp 183° C. (dec).

EXAMPLE 2 Synthesis of trimebutine cysteinyl-nitroargininate (II)

Synthesis of2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b)

To a solution of Boc-Cys(Trt)-OH (3.0 mmol) in 50 mL ofdimethylformamide, hydroxybenzotriazole (3.3 mmol) and DCC (3.3 mmol)were added with stirring at 0° C. for 1 h. To the reaction mixture,H-Arg(NO₂)-OtBu (3.0 mmol) was added and stirred mechanically for 3 h at0° C. and 24 h at room temperature. After filtration, the filtrate wasevaporated under reduced pressure to remove the solvent. The oilyresidue thus obtained was dissolved in ethyl acetate; the organic layerwas washed with brine, dried on anhydrous MgSO₄, filtered and thesolvent evaporated. The crude intermediate a was treated with a solutionof trifluoroacetic acid in dichloromethane (40% TFA in DCM). After 1 hthe solvent was removed to obtain H-Cys-Arg(NO₂)—OH.TFA as a cruderesidue which was precipitated with diethyl ether; the obtained solidwas dissolved in water and 1N NaOH was slowly added to obtain2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b) as a white solid which was recovered by filtration.

Synthesis of trimebutine cysteinyl-nitroargininate (II)

To a mixture of2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b; 0.1 mole) and trimebutine (0.1 mole), water (200 mL) and ethylalcohol (20 mL) have been added and the resulting suspension has beenstirred at room temperature until clear. Then the solution has beenfrozen and lyophilized furnishing the desired salt (quantitative yield).

EXAMPLE 3 Synthesis of trimebutine thiocarbamoylbenzoate (III)Preparation of 3,4,5-trimethoxybenzoic acid2-(dimethylamino)-2-phenylbutyl ester 4-thiocarbamoyl benzoate(Trimebutine thiocarbamoylbenzoate)

To a mixture of 4-(thiocarbamoyl)benzoic acid (0.1 mol) and trimebutine(0.1 mol), water (200 mL) and ethyl alcohol (20 mL) have been added andthe resulting suspension has been stirred at room temperature untilclear. Then the solution has been frozen and lyophilized furnishing thedesired salt (quantitative yield).

¹H-NMR (400 MHz, DMSO-d₆): δ 0.60 (t, 3H), 1.45-1.75 (m, 4H), 1.80-1.90(m, 2H), 2.28 (s, 6H), 2.90-3.40 (m, 2H), 3.69 (s, 9H), 3.95 (m, 1H),4.73 (dd, 2H), 7.01 (s, 2H), 7.22 (t, 1H), 7.35 (t, 2H), 7.46 (d, 2H)7.93 (dd, 4H), 9.65 (bs, 1H, NH), 10.05 (bs, 1H, NH).

¹³C-NMR (400 MHz, DMSO-d₆): δ 9.07, 28.9, 56.5, 60.8, 64.5, 65.7, 107.1,125.3, 127.4, 128.1, 128.6, 129.5, 129.7, 132.3, 141.8, 142.5, 148.5,153.4, 154.8, 165.9, 169.4, 172.5, 188.6.

mp 66-68° C. (dec).

Synthesis of 4-(thiocarbamoyl)benzoic acid

The compound was synthesized according to a procedure already reportedin literature (Fairfull, E. S., Lowe J. L., Peak D. A. J. Chem. Soc.1952, 742), incorporated herein by reference.

4-(Thiocarbamoyl)benzoic acid (2)

3 g of 4-cyanobenzoic acid 1 (20.4 mmol) were dissolved in 40 mL ofpyridine and 2.1 mL of triethylamine (20.4 mmol) were added. Dryhydrogen sulphide was passed through the solution in a steady steam for4 h. The mixture was then poured into water and the solid collected byfiltration. Recrystallization from petroleum ether furnished 2.51 g ofthe pure compound 2 (68%yield).

MS (ESI), m/e 182.2 (M⁺).

¹H NMR (DMSO-d₆): δ 7.92 (dd, 4H), 9.68 (s, 1H, NH), 10.12 (s, 1H, NH),13.25 (s, 1H, OH).

¹³C NMR (DMSO-d₆): δ 127.3, 129. 6, 132.0, 148.5, 169.4, 188.6

m.p. 296-298° C. (dec.)

EXAMPLE 4 Synthesis of trimebutine ADT-nitroargininate (IV)

Synthesis of carbonic acid 4-nitro-phenyl ester4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenyl ester (a)

To a stirred suspension of ADT-OH (1.04 mmol) in CH₂Cl₂ (10 ml) wasadded 4-dimethylaminopyridine. (DMAP, 1.16 mmol) and 4-nitrophenylchloroformate (1.15 mmol). The reaction mixture was stirred for 10 hr atroom temperature. Thin layer chromatography indicated that the formationof the desired product completed. The solvent was removed and theresidue was treated with diethyl ether; product a was recovered byfiltration and used without further purification (yield 81%).

Synthesis of5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b)

To the solution of a (1.04 mmol) in 50 mL of CH₂Cl₂ were added4-dimethylaminopyridine (1.16 mmol) and H-Arg(NO₂)-OtBu (1.02 mmol) andthe solution was stirred for 20 hr at room temperature. Then, thereaction mixture was diluted with CH₂Cl₂, washed with sat. NaHCO₃ andsat. NaCl, and dried over MgSO₄. The crude intermediate was treated witha solution of trifluoroacetic acid in dichloromethane (40% TFA in DCM).After 1 h the solvent was removed to obtain product b as a crude residuewhich was precipitated with diethyl ether; the obtained solid wasdissolved in water and 1N NaOH was slowly added to obtain5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b) as a white solid which was recovered by filtration.

Synthesis of trimebutine ADT-nitroargininate (IV)

To a mixture of5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b; 0.1 mol) and trimebutine (0.1 mol), water (200 mL) and ethylalcohol (20 mL) have been added and the resulting suspension has beenstirred at room temperature until clear. Then the solution has beenfrozen and lyophilized furnishing the desired salt (quantitative yield).

EXAMPLE 5 Synthesis of trimebutinep-hydroxythiobenzamide-nitroargininate (V)

Synthesis of carbonic acid 4-nitro-phenyl ester 4-thiocarbamoyl-phenylester (a)

To a stirred suspension of p-hydroxythiobenzamide (1.04 mmol) in CH₂Cl₂(10 ml) was added 4-dimethylaminopyridine (DMAP, 1.16 mmol) and4-nitrophenyl chloroformate (1.15 mmol). The reaction mixture wasstirred for 10 hr at room temperature. Thin layer chromatographyindicated that the formation of the desired product completed. Thesolvent was removed and the residue was treated with diethyl ether;product a was recovered by filtration and used without furtherpurification (yield 81%).

Synthesis of5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b)

To the solution of a (1.04 mmol) in 50 mL of CH₂Cl₂ were added4-dimethylaminopyridine (1.16 mmol) and H-Arg(NO₂)-OtBu (1.02 mmol) andthe solution was stirred for 20 hr at room temperature. Then, thereaction mixture was diluted with CH2Cl₂, washed with sat. NaHCO₃ andsat. NaCl, and dried over MgSO₄. The crude intermediate was treated witha solution of trifluoroacetic acid in dichloromethane (40% TFA in DCM).After 1 h the solvent was removed to obtain product b as a crude residuewhich was precipitated with diethyl ether; the obtained solid wasdissolved in water and 1N NaOH was slowly added to obtain5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b) as a white solid which was recovered by filtration.

Synthesis of trimebutine p-hydroxythiobenzamide-nitroargininate (V)

To a mixture of5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b; 0.1 mole) and trimebutine (0.1 mole), water (200 mL) and ethylalcohol (20 mL) have been added and the resulting suspension has beenstirred at room temperature until clear. Then the solution has beenfrozen and lyophilized furnishing the desired salt (quantitative yield).

EXAMPLE 6 Synthesis of N-desmethyltrimebutine nitroargininate (VI)

To a mixture of H-Arg(NO₂)—OH (0.1 mol) and N-desmethyltrimebutine (0.1mol), water (200 mL) and ethyl alcohol (20 mL) have been added and theresulting suspension has been stirred at room temperature until clear.Then the solution has been frozen and lyophilized furnishing the desiredsalt (quantitative yield).

¹H-NMR (400 MHz, DMSO-d₆): δ 0.72 (t, 3H), 1.45-1.75 (m, 4H), 1.80-1.90(m, 2H), 2.07 (s, 3H), 2.90-3.40 (m, 2H), 3.75 (s, 9H), 3.95 (m, 1H),4.64 (dd, 2H), 7.07 (s, 2H), 7.22 (t, 1H), 7.35 (t, 2H), 7.51 (d, 2H).

¹³C-NMR (400 MHz, DMSO-d₆): δ 9.07, 22.8, 26.4, 28.9, 29.1, 47.9, 56.4,60.8, 64.4, 65.8, 107.3, 125.2, 127.4, 128.0, 128.5, 141.7, 142.5,153.4, 158.3, 165.9, 170.2.

m.p. 78-80° C. (dec)

Synthesis of N-desmethyltrimebutine

The compound was synthesized following with slight modifications theprocedure reported in literature (Martin, A., Figadere B., Saivin S.,Houin G., Chomard J. M., Cahiez G. Arzneim.-Forsch./Drug Res. 2000 (50),544).

Phenylglycin ethylester hydrochloride (2)

22 mL of SOCl₂ were added dropwise to a solution of 30 g of phenylglycin1 (198.5 mmol) in 200 mL of anhydrous ethanol. A gentle reflux occurredspontaneously and it was maintained for 3 h. The reaction was allowed tocool to room temperature and was stirred overnight. The solvent wasremoved under vacuum to afford 41.8 g of 2 as a white powder (98%yield).

MS (ESI), m/e 179.8 (M⁺).

Ethyl N-(phenylmethylene)glycinate (3)

To a mixture of 10.6 g of ethyl phenylglycinate hydrochloride 2 (49.3mmol), 100 mL of dichloromethane, 5 ml of benzaldehyde (49.2 mmol) and30 g of magnesium sulfate (249.2 mmol) were added at room temperature,under a nitrogen atmosphere, 21.25 mL of triethylamine (152.46 mmol).After stirring for 17 h the heterogeneous reaction mixture was filteredthrough celite and the solid was washed with 100 mL of dichloromethane.The solvents were evaporated under reduced pressure and the viscous oilthus obtained was stirred with 80 mL of diethyl ether and 80 mL of wateruntil dissolution. After decantation, the organic layer was dried oversodium sulphate and the solvent was evaporated under vacuum. The immineester 3 (12.4 g, 94% yield) was obtained as a yellow pale oil.

MS (ESI), m/e 268.3 (M⁺).

Ethyl 2-phenyl-2-(N-phenylmethylene)-butanoate (4)

Under a nitrogen atmosphere, a solution of 12.39 g (46.4 mmol) of 3 in64 mL of anhydrous THF was added dropwise, under stirring, to a mixtureof 2.04 of sodium hydride (60% oil dispersion, 85 mmol), 192 mg of CuCl₂and 128 mL of anhydrous THF. After 9 h at room temperature, 4.66 mL(57.7 mmol) of ethyl iodide were quickly added to the reaction mixture.Stirring was continued for 18 h and 0.86 mL of anhydrous ethanol wereadded cautiously to the reaction mixture. During the stirring thereaction colour changed from yellow to red to orange and then to green.After concentration of the reaction mixture under vacuum, 95.8 mL ofdiethyl ether and 160 mL water were added and the resulting mixture wasstirred for 10 minutes, then filtered through celite. After decantationthe organic layer was washed three times with water and dried oversodium sulphate, then the diethyl ether was evaporated under reducedpressure to furnish 5.82 g of 4 (43% yield). The crude product, obtainedas a yellow-orange oil, was pure enough to be used without furtherpurification.

MS (ESI), m/e 296.1 (M⁺).

Ethyl 2-amino-2-phenylbutanoate hydrochloride (5)

5.8 g of 4 (19.73 mmol), 17.6 mL of THF, 35.17 mL of diethyl ether, 44mL of water and 2.64 mL of concentrated HCl were stirred at roomtemperature for 24 h. Solvents were removed from reaction mixture undervacuum and the resulting aqueous solution was washed twice with diethylether. Water was then evaporated under reduced pressure to give 3.8 g of5 as an orange oil (79% yield).

Ethyl 2-amino-2-phenylbutanoate (6)

The crude product 5 was dissolved in 22 mL of anhydrous THF and 2.64 mLof triethyl amine were added. After stirring for 30 minutes, the mixturewas filtered through celite and the solid washed with 100 mL ofanhydrous diethyl ether. Concentration of the solvents using a rotaryevaporator afforded 2.49 g of 6 as a blue oil (77% yield).

MS (ESI), m/e 208 (M⁺).

Ethyl 2-Formylamino-2-phenylbutanoate (7)

12.72 mL of formic acid then 25.38 mL of acetic anhydride were addeddropwise, under stirring, to 2.49 g (12.03 mmol) of amine 6. After 15 hat room temperature, solvents were removed under reduced pressure togive 3.09 g of 7 as a green viscous oil (100% yield).

Rf=0.85 (CHCl₃/MeOH 9.5:0.5)

MS (ESI), m/e 236 (M⁺).

2-Methylamino-2-phenylbutanol (8)

To a suspension of 900 mg (23.71 mmol) of lithium aluminium hydride(LiAlH₄) in 30 mL of anhydrous THF were added dropwise a solution of3.09 g (13.15 mmol) of 7, previously prepared, in 18 mL of anhydrousTHF. After 4 h under reflux, the reaction mixture was allowed to cool toroom temperature and an additional amount of lithium aluminium hydride(900 mg) was introduced. Reflux was maintained for 4 h then an aqueoussaturated solution of magnesium sulfate was slowly added at −10° C.under vigorous stirring until formation of a precipitate. The solid wasfiltered and washed several times with THF. The organic solvent wasevaporated under reduced pressure until obtaining of an aqueoussolution. The solution was added with 100 mL of diethyl ether and theorganic layer was dried over sodium sulfate. Evaporation of the solventafforded 1.84 g of 8 as a yellow oil. (78% yield).

MS (ESI), m/e 180.1 (M⁺).

(2-Methylamino-2-phenylbutyl)3,4,5-trimethoxybenzoate(N-desmethyltrimebutine (9)

To a solution of 1.84 g of 8 (10.3 mmol) in 28 mL of anhydrous THF wereadded dropwise, at −78° C., 4.11 mL of n-BuLi (2.5 mol/L in hexanes).After 15 minutes, a solution of 2.31 g (10.01 mmol) of3,4,5-trimethoxybenzoyl chloride in 15.8 mL of anhydrous THF was added.The reaction mixture was then allowed to warm to −30° C. (ca 1 h) and 19mL of acetic acid were cautiously added. Solvents were removed undervacuum and 55 mL of diethyl ether and 55 mL of water were added to thepreviously obtained oil. After stirring until complete dissolution, theresulting mixture was then decanted and the aqueous layer alcalinizedcompletely with solid Na₂CO₃ and re-extracted with diethyl ether. Theorganic layers were washed twice with a saturated aqueous solution ofsodium carbonate and with brine and then dried over sodium sulphate.Diethyl ether was evaporated under vacuum and the ester 9 was purifiedby chromatography on silica gel column (ethyl acetate/n-hexane, 7:3) togive 1.4 g of pure N-desmethyltrimebutine 9 (49% yield) as a yellow paleoil. MS (ESI), m/e 374.1 (M⁺).

¹H NMR (CDCl₃): δ 0.72 (t, 3H), 1.7 (s, 1H, NH), 1.75-1.9 (m, 2H), 2.6(s, 3H), 3.76 (s, 6H), 3.80 (s, 3H), 4.50 (dd, 2H), 7.07-7.44 (m, 7H).

¹³C NMR (DMSO-d₆): δ 7.4, 28.5, 28.6, 55.9, 60.1, 61.1, 66.3, 100.5,126.5, 127.0, 129.3, 128.0, 142.0, 142.5, 152.7, 165.6.

EXAMPLE 7 Synthesis of N-desmethyltrimebutine cysteinyl-nitroargininate(VII)

Synthesis of2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b)

To a solution of Boc-Cys(Trt)-OH (3.0 mmol) in 50 mL ofdimethylformamide, hydroxybenzotriazole (3.3 mmol) and DCC (3.3 mmol)were added with stirring at 0° C. for 1 h. To the reaction mixture,H-Arg(NO₂)-OtBu (3.0 mmol) was added and stirred mechanically for 3 h at0° C. and 24 h at room temperature. After filtration, the filtrate wasevaporated under reduced pressure to remove the solvent. The oilyresidue thus obtained was dissolved in ethyl acetate; the organic layerwas washed with brine, dried on anhydrous MgSO₄, filtered and thesolvent evaporated. The crude intermediate a was treated with a solutionof trifluoroacetic acid in dichloromethane (40% TFA in DCM). After 1 hthe solvent was removed to obtain H-Cys-Arg(NO₂)-OH.TFA as a cruderesidue which was precipitated with diethyl ether; the obtained solidwas dissolved in water and 1N NaOH was slowly added to obtain2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b) as a white solid which was recovered by filtration.

Synthesis of N-desmethyltrimebutine cysteinyl-nitroargininate (VII)

To a mixture of2-(2-amino-3-mercapto-propionylamino)-5-nitroguanidino-pentanoic acid(b; 0.1 mole) and N-desmethyltrimebutine (0.1 mole), water (200 mL) andethyl alcohol (20 mL) have been added and the resulting suspension hasbeen stirred at room temperature until clear. Then the solution has beenfrozen and lyophilized furnishing the desired salt (quantitative yield).

EXAMPLE 8 Preparation of 3,4,5-trimethoxybenzoic acid2-(methylamino)-2-phenylbutyl ester 4-thiocarbamoyl benzoate(N-desmethyltrimebutine thiocarbamoylbenzoate (VIII)

A mixture of 4-(thiocarbamoyl)benzoic acid (0.1 mol) anddesmethyltrimebutine (0.1 mol) was dissolved in ethyl alcohol (20 mL)and acetonitrile (20 mL), then water (200 mL) has been added and theresulting suspension has been stirred at room temperature until clear.Then the solution has been frozen and lyophilized furnishing the desiredsalt (quantitative yield).

¹H-NMR (400 MHz, DMSO-d₆): δ 0.72 (t, 3H), 1.70-1.80 (m, 4H), 1.80-1.90(m, 2H), 2.08 (s, 3H), 2.90-3.40 (m, 2H), 3.69 (s, 9H), 3.95 (m, 1H),4.41 (dd, 2H), 7.07 (s, 2H), 7.22 (t, 1H), 7.33 (t, 2H), 7.52 (d, 2H)7.93 (dd, 4H), 9.63 (bs, 1H, NH), 10.02 (bs, 1H, NH).

¹³C-NMR (400 MHz, DMSO-d₆): δ 9.07, 28.7, 56.5, 60.5, 64.6, 65.8, 107.2,125.5, 127.2, 128.2, 128.6, 129.5, 129.4, 132.5, 141.9, 142.4, 148.5,153.5, 154.7, 165.7, 169.4, 172.5, 188.6.

mp 65-67° C. (dec.)

EXAMPLE 9 Synthesis of N-desmethyltrimebutine ADT-nitroargininate (IX)

Synthesis of carbonic acid 4-nitro-phenyl ester4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenyl ester (a)

To a stirred suspension of ADT-OH (1.04 mmol) in CH₂Cl₂ (10 ml) wasadded 4-dimethylaminopyridine (DMAP, 1.16 mmol) and 4-nitrophenylchloroformate (1.15 mmol). The reaction mixture was stirred for 10 hr atroom temperature. Thin layer chromatography indicated that the formationof the desired product completed. The solvent was removed and theresidue was treated with diethyl ether; product a was recovered byfiltration and used without further purification (yield 81%).

Synthesis of5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b)

To the solution of a (1.04 mmol) in 50 mL of CH₂Cl₂ were added4-dimethylaminopyridine (1.16 mmol) and H-Arg(NO₂)-OtBu (1.02 mmol) andthe solution was stirred for 20 hr at room temperature. Then, thereaction mixture was diluted with CH₂Cl₂, washed with sat. NaHCO₃ andsat. NaCl, and dried over MgSO₄. The crude intermediate was treated witha solution of trifluoroacetic acid in dichloromethane (40% TFA in DCM).After 1 h the solvent was removed to obtain product b as a crude residuewhich was precipitated with diethyl ether; the obtained solid wasdissolved in water and 1N NaOH was slowly added to obtain5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b) as a white solid which was recovered by filtration.

Synthesis of N-desmethyltrimebutine ADT-nitroargininate (IX)

To a mixture of5-nitroguanidino-2-[4-(5-thioxo-5H-[1,2]dithiol-3-yl)-phenoxycarbonyl-amino]-pentanoicacid (b; 0.1 mol) and N-desmethyltrimebutine (0.1 mol), water (200 mL)and ethyl alcohol (20 mL) have been added and the resulting suspensionhas been stirred at room temperature until clear. Then the solution hasbeen frozen and lyophilized furnishing the desired salt (quantitativeyield).

EXAMPLE 10 Synthesis of N-desmethyltrimebutine p-hydroxythiobenzamidenitro-argininate (X)

Synthesis of carbonic acid 4-nitro-phenyl ester 4-thiocarbamoyl-phenylester (a)

To a stirred suspension of p-hydroxythiobenzamide (1.04 mmol) in CH₂Cl₂(10 ml) was added 4-dimethylaminopyridine (DMAP, 1.16 mmol) and4-nitrophenyl chloroformate (1.15 mmol). The reaction mixture wasstirred for 10 hr at room temperature. Thin layer chromatographyindicated that the formation of the desired product completed. Thesolvent was removed and the residue was treated with diethyl ether;product a was recovered by filtration and used without furtherpurification (yield 81%).

Synthesis of5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b)

To the solution of a (1.04 mmol) in 50 mL of CH₂Cl₂ were added4-dimethylaminopyridine (1.16 mmol) and H-Arg(NO₂)-OtBu (1.02 mmol) andthe solution was stirred for 20 hr at room temperature. Then, thereaction mixture was diluted with CH₂Cl₂, washed with sat. NaHCO₃ andsat. NaCl, and dried over MgSO₄. The crude intermediate was treated witha solution of trifluoroacetic acid in dichloromethane (40% TFA in DCM).After 1 h the solvent was removed to obtain product b as a crude residuewhich was precipitated with diethyl ether; the obtained solid wasdissolved in water and 1N NaOH was slowly added to obtain5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b) as a white solid which was recovered by filtration.

Synthesis of N-desmethyltrimebutinep-hydroxythiobenzamide-nitroargininate (X)

To a mixture of5-nitroguanidino-2-(4-thiocarbamoyl-phenoxycarbonylamino)-pentanoic acid(b; 0.1 mole) and N-desmethyltrimebutine (0.1 mole), water (200 mL) andethyl alcohol (20 mL) have been added and the resulting suspension hasbeen stirred at room temperature until clear. Then the solution has beenfrozen and lyophilized furnishing the desired salt (quantitative yield).

Testing of Compounds EXAMPLE 11 Comparison of the Effects of Salt I,Trimebutine Nitroargininate, Versus Trimebutine Alone and NitroarginineAlone in a Rat Model of Visceral Pain Perception

A rat model of visceral pain perception, a pre-clinical model ofirritable bowel syndrome, was used in the following example. Rats (male,Wistar, 200-250 g, obtained from Charles River, Monza, Italy), werehoused in plastic cages and maintained under controlled conditions with12-hours light/dark cycle with lights on at 7.00 AM. Tap water andstandard laboratory chow were freely available. Before experiments, ratswere individually trained by spending 2-3 hours per day in a plexiglasscage for 2-3 days. It allowed them to adjust to a movement-restrictionenvironment. Food was withheld for 12 hours before colorectal distension(CRD) recording were performed. Experiments were performed in awake ratsand were conducted in a blind manner in that the observer was not awareof the identity of drug administered to each animal.

On the testing day, rats were sedated with ether inhalation and a 2 cmlong latex balloon was inserted intrarectally 2 cm from the anal vergeand fixed at the base of the tail. The balloon was connected via adouble-barreled cannula to a pressure transducer to continuouslymonitoring the rectal pressure by a computer (PowerLab PC, A.D.Instruments, Milford, Mass., USA) and to a syringe forinflation/deflation of the balloon. The rats were then housed in a smallcage (20×8×8 cm) on an elevated Plexiglas™ platform and allowed to wakeup and adapt for 1 hour. After recovery from sedation, animals underwentthe CRD procedure and behavioral responses were tested. The night beforethe experiments, the balloons were inflated and left overnight so thelatex stretched and the balloons became compliant.

CRD of 20 seconds, performed every 5 minutes, was applied in incrementof 0.4 ml starting from 0.4 ml up to 1.6 ml water. To achieve anaccurate measurement of the colonic parameters and perception, thedistensions were repeated twice for each intensity and data for eachanimal were averaged for analysis. Each animal underwent a double set ofCRD. Twenty minutes after the first sequence of CRD (0.4 mL-1.6 mlwater), drugs were administered intraperitoneally (i.p.) and a secondset of CRD was performed. Behavioral responses during the first and thesecond set of CRD were assessed and compared.

Behavioral response to CRD was assessed by measuring the abdominalwithdrawal reflex (AWR) using a semi-quantitative score (1). The AWR isan involuntary motor reflex similar to the visceromotor reflex, but ithas the great advantage that, in contrast to the latter, it does notrequire abdominal surgery to implant recording electrodes and wires inthe abdominal muscle wall which may cause additional sensitization (seeNess, T. J. and Gebhart, G. F. (1990) Pain 41:167-234, incorporatedherein by reference).

Measurement of the AWR consisted of visual observation of the animalresponse to graded CRD by blinded observer and assignment of an AWRscore according with the behavioral scale as previously described inAl-Chaer, E. D. et al. (2000) Gastroenterology 19: 1276-85, incorporatedherein by reference, in which grade 0 corresponds to no behavioralresponse to CRD, grade 1 corresponds to brief head movement at the onsetof the stimulus followed by immobility, grade 2 corresponds to a mildcontraction of abdominal muscles although the rats does not lift theabdomen off the platform, grade 3 corresponds to a strong contraction ofthe abdominal muscles with the lifting of the abdomen off the platform,and grade 4 corresponds to a severe contraction of the abdominal musclemanifested by body arching and the lifting of the abdomen and of thepelvic structures and scrotum.

The effects of trimebutine maleate, nitroarginine and trimebutinenitroargininate on colonic compliance and sensitivity were determinedusing a total of 15 fasting rats. To investigate whether theadministration of trimebutine maleate, nitroarginine and trimebutinenitroargininate could reduce pain induced by CRD, after the firstsequence of CRD (vehicle-treated), 5 rats were treated with trimebutinemaleate at a dose of 10 mg/kg i.p., nitroarginine at a dose of 6 mg/kgor trimebutine nitroargininate at the dose of 16 mg/kg i.p., after whicha second set of CRD was repeated. Results from these experiments areshown in FIGS. 1( a), 2(a) and 3(a).

To determine the effect of trimebutine maleate, nitroarginine andtrimebutine nitroargininate on colonic smooth muscle, the compliance ofthe colo-rectum during CRD was obtained from intracolo-rectal volume andpressure and expressed as mL/mmHg. These results are shown in FIGS. 1(b), 2(b) and 3(b).

To determine the role of NO in the visceral analgesic effects oftrimebutine nitroargininate, experiments were performed in which ratswere pretreated 10 min before administration of trimebutinenitroargininate (16 mg/kg i.p.) or vehicle with methylene blue (1 mg/kgi.p.), L-NAME (25 mg/kg i.v.) or vehicle. The results are shown in FIGS.4( a) and 4(b).

All data are presented as the mean±SEM, with sample sizes of 5rats/group; statistical comparison of data was performed by theStudent's paired t-test. An associated probability (p value) of lessthat 5% was considered significant, as indicated by an asterisk.

FIGS. 1( a), 2(a) and 3(a) show that trimebutine nitroargininate is moreeffective than either trimebutine maleate or nitroarginine in reducingvisceral pain in response to colorectal distension. However, none of thecompounds were particularly effective in reducing intrarectal pressure,as shown in FIGS. 1( b), 2(b) and 3(b). FIGS. 4( a) and 4(b) show thatthe visceral analgesic effects of trimebutine nitroargininate arelargely abolished by pretreatment with an inhibitor of nitric oxidesynthase (L-NAME) or with an inhibitor of soluble guanylate cyclase(methylene blue). These results suggest that release of nitric oxidefrom trimebutine nitroargininate, and stimulation of soluble guanylatecyclase, contribute significantly to the visceral analgesic effects ofthis compound.

Thus, trimebutine nitroargininate is useful in treating abdominal painassociated with various inflammatory conditions of the alimentary tract,as well as functional gastrointestinal disorders such as irritable bowelsyndrome, dyspepsia, etc., that are characterized by increased visceralnociception (with or without accompanying inflammation).

EXAMPLE 12 Comparison of the Effects of Salt III, TrimebutineThiocarbamoylbenzoate, Versus Trimebutine Alone andThiocarbamoylbenzoate Alone, in a Rat Model of Visceral Pain Perception

Experiments were carried out as described in Example 11, except thatgroups of 5 rats each were treated with vehicle, trimebutine maleate (10mg/kg), or with equimolar doses of trimebutine thiocarbamoylbenzoate(salt III) or thiocarbamolybenzoate alone.

FIGS. 5( a) and 5(b) show that trimebutine thiocarbamoylbenzoate is moreeffective than either trimebutine maleate or thiocarbamoylbenzoate inreducing visceral pain in response to colorectal distension.

Thus, trimebutine thiocarbamoylbenzoate is useful in treating abdominalpain associated with various inflammatory conditions of the alimentarytract, as well as functional gastrointestinal disorders such asirritable bowel syndrome, dyspepsia, etc., that are characterized byincreased visceral nociception (with or without accompanyinginflammation).

EXAMPLE 13 Generation of H₂S by 4-(thiocarbamoyl)benzoic acid and5-(4-Amino-phenyl)-[1,2]dithiole-3-thione

Two compounds were tested, 5-(4-Amino-phenyl)-[1,2]dithiole-3-thione(ADT-OH) and 4-(thiocarbamoyl)benzoic acid (TBZ) for H₂S generationunder three different conditions for H₂S generation. In particular,concentrations of H₂S generated within 1 hour from 1 mM concentrationsADT-OH and TBZ were measured. H₂S release was tested under threeconditions: (i) when the compound was in buffer, (ii) when the compoundwas in a liver homogenate, and (iii) when the compound was in the liverhomogenate together with an inhibitor of H₂S synthesis, which blocks theactivity of the enzyme an inhibitor of cystathionine-γ-lyase(PAG=DL-propargylglycine; 2 mM). Results are shown in FIG. 6. Asterisk(*) indicates a significant (p<0.05) increase versus correspondingvehicle-treated group. The alpha (α) represents a significant decreasein H₂S synthesis as a result of incubation in the presence of PAG.

1. A compound of the general formula:A⁺·X⁻ where: A is

and their corresponding stereoisomers; and X is a NO-releasing, anH₂S-releasing moiety, or a combined NO- and H₂S-releasing moiety.
 2. Thecompound of claim 1, wherein X is selected from the group consisting of:


3. The compound according to claim 2 where the compound is trimebutinenitroargininate.
 4. The compound according to claim 2 where the compoundis trimebutine cysteinyl-nitroargininate.
 5. The compound according toclaim 2 where the compound is trimebutine thiocarbamoyl benzoate.
 6. Thecompound according to claim 2 where the compound is trimebutine5-phenyl-1,2-dithione-3-thione-nitroargininate.
 7. The compoundaccording to claim 2 where the compound is trimebutinep-hydroxythiobenzamide-nitroargininate.
 8. The compound according toclaim 2 where the compound is N-desmethyltrimebutine nitroargininate. 9.The compound according to claim 2 where the compound isN-desmethyltrimebutine cysteinyl-nitroargininate.
 10. The compoundaccording to claim 2 wherein the compound is N-desmethyltrimebutinethiocarbamoylbenzoate.
 11. The compound according to claim 2 wherein thecompound is N-desmethyltrimebutine5-phenyl-1,2-dithione-3-thione-nitroargininate
 12. The compoundaccording to claim 2 wherein the compound is N-desmethyltrimebutinep-hydroxythiobenzamide-nitroargininate.
 13. A pharmaceutical compositioncomprising a compound as claimed in claim 2 and a pharmaceuticallyacceptable excipient or carrier.
 14. A method for treating visceral painin a subject in need of such treatment comprising administering to thesubject a visceral pain relieving amount of a compound according toclaim
 2. 15. A method as claimed in claim 14, wherein the visceral painis abdominal pain.
 16. A method as claimed in claim 15, wherein theabdominal pain is due to intestinal diseases such as inflammatory boweldisease (IBD), irritable bowel syndrome (IBS), diabetic gastroparesis,and dyspepsia.
 17. A compound having the general formulanitroarginine-R, wherein R is an H₂S-releasing moiety, for thepreparation of salts of trimebutine and N-monodesmethyl trimebutine. 18.A compound as claimed in claim 17, wherein R is selected from the groupconsisting of 5-p-hydroxyphenyl-1,2-dithione-3-thione, cysteine, and4-(thiocarbamoyl)benzoic acid.
 19. (canceled)
 20. (canceled) 21.(canceled)